Perioperative Management of Patients with Down Syndrome

Haché, Manon
Sun, Lena S.

¹Department of Anesthesiology, ²Department of Pediatrics, Columbia University, 622 W, 168^th Street, BH 440-N, New York, NY 10032, USA

^*Address correspondence to this author at the Department of Anesthesiology, Columbia University, 622 W, 168^thStreet, BH 440-N, New York, NY 10032, USA; Tel: (212) 305-8337; Fax: (212) 305-2395; E-mail: [email protected]

Current Pediatric Reviews 5(3):p 180-183, 2009.

Abstract:

Down syndrome is probably the most widely recognized chromosomal disorder. With an incidence of 1 in 600-800 live births, it is associated with a predictable pattern of congenital abnormalities. Patients with Down syndrome can present with a wide range of disease entities requiring surgery, some of which include congenital cardiac disorders, airway abnormalities and gastrointestinal malformations. This review article is intended to guide pediatricians through the perioperative care of these patients, as they will often be consulted either to provide preoperative evaluation and optimization of underlying diseases or to evaluate patients for postoperative issues. It is important for pediatricians to understand the specific anesthetic implications of patients with Down syndrome in order to better prepare them for surgery and appropriately handle any postoperative complications. We will review important perioperative considerations in children with a special attention to issues pertaining to patients with Down syndrome, such as:

Psychological preparation
Airway evaluation, atlantoaxial instability
Sleep apnea
Congenital cardiac disease
Hematological diseases
Thyroid dysfunction
Gastrointestinal problems
Neurologic problems

We will also discuss considerations specific to surgical procedures more commonly performed in Down syndrome patients.